EXTENDED REPORT

Corneal ulceration in south-east Asia III: prevention of fungal keratitis at the village level in south India using topical antibiotics

M Srinivasan¹, M P Upadhyay², B Priyadarsini¹, R Mahalakshmi¹ and J P Whitcher³

¹ Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
² B P Eye Foundation, Kathmandu, Nepal
³ Francis I Proctor Foundation for Research in Ophthalmology, University of California San Francisco, San Francisco, California, USA

Correspondence to:
Correspondence to:
J P Whitcher
Francis I Proctor Foundation, UCSF Box 0944, 95 Kirkham Street, San Francisco, CA 94143-0944, USA;jack.whitcher{at}ucsf.edu

Aim: To determine whether topical antifungal prophylaxis distributed by paid village health workers (VHWs) in south India is necessary after corneal abrasion to prevent fungal keratitis in a population where half of the ulcers are fungal.

Methods: Two panchayaths (village administrative units in Madurai district with a combined population of 48 039 were followed prospectively for 18 months by 15 VHWs who were trained to identify post-traumatic corneal abrasions. Patients fulfilling the eligibility criteria were randomised into two groups and treated with either 1% chloramphenicol and 1% clotrimazole ointment or 1% chloramphenicol and a placebo ointment three times a day for 3 days. Patients, doctors and VHWs were blinded to treatment.

Results: During the 18-month period, 1365 people reported to VHWs with ocular injuries, of whom 374 with corneal abrasions were eligible for treatment. Of these, 368 (98.5%) abrasions healed without complications. Two patients had mild localised allergic reactions to the ointment, two dropped out and two patients in the placebo group developed microscopic culture-negative corneal stromal infiltrates that healed in 1 week with natamycin drops.

Conclusions: Both fungal and bacterial ulcers that occur after traumatic corneal abrasions seem to be effectively prevented in a village setting using only antibiotic prophylaxis.

Abbreviations: VHWs, village health workers

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